Job purpose

The Reimbursement Specialist is an integral member of the reimbursement team and has primary responsibility for the timely initiation of initial and reauthorizations with insurance carriers for established patients. The representative will also be in contact with the physician office and sales staff for additional clinical information, progress notes and additional testing when required.

Duties and responsibilities

• Works with insurance carriers to authorize service for patients.
• Obtains necessary documentation for continued authorization as dictated by payer, including updated clinical information or forms.
• Contacts the client, physician office and sales representative to relay or obtain pertinent information and documentation to ensure continued coverage.
• Completes weekly follow up with physicians or sales team to obtain updated clinical for existing patients. Interacts with sales staff as needed to obtain required documentation.
• Responsible for generation of all reauthorization requests based on initial expiration.
• Negotiates favorable rates with insurance carriers to guarantee assignment of benefits and determine appropriate fee schedules for the billing process.
• Performs other duties as assigned by Management.

Qualifications

• H.S. Diploma or equivalent required. Bachelor’s degree preferred
• Superior communication and customer service skills, and ability to handle multiple tasks simultaneously under strict deadlines.
• Minimum of 1-2 years’ experience in customer service, medical insurance verification, benefits or related area required, or Bachelor’s degree and 1-year of relevant experience
• Strong negotiation skills.
• Experience working with all payer types to include Medicare, Medicaid and third-party commercial insurance companies.
• Superior communication, customer service skills and strong phone presence.
• Ability to handle multiple tasks simultaneously under strict deadlines.
• Proficiency in MS Excel, email programs and online data systems.

Job Type: Full-time

Pay: $19.50 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 10 hour shift
• 8 hour shift
• Day shift
• Evening shift
• Monday to Friday
• Overtime
• Weekends as needed

Work setting:

• Hybrid work
• Office

Work Location: Hybrid remote in Pittsburgh, PA 15238